A Review of Abdominal Meshes for Hernia Repair-Current Status and Emerging Solutions.

Abdominal hernias are common issues in the clinical setting, burdening millions of patients worldwide. Associated with pain, decreased quality of life, and severe potential complications, abdominal wall hernias should be treated as soon as possible. Whether an open repair or laparoscopic surgical approach is tackled, mesh reinforcement is generally required to ensure a durable hernia repair. Over the years, numerous mesh products have been made available on the market and in clinical settings, yet each of the currently used meshes presents certain limitations that reflect on treatment outcomes. Thus, mesh development is still ongoing, and emerging solutions have reached various testing stages. In this regard, this paper aims to establish an up-to-date framework on abdominal meshes, briefly overviewing currently available solutions for hernia repair and discussing in detail the most recent advances in the field. Particularly, there are presented the developments in lightweight materials, meshes with improved attachment, antimicrobial fabrics, composite and hybrid textiles, and performant mesh designs, followed by a systematic review of recently completed clinical trials.

Novel Material Optimization Strategies for Developing Upgraded Abdominal Meshes.

Over 20 million hernias are operated on globally per year, with most interventions requiring mesh reinforcement. A wide range of such medical devices are currently available on the market, most fabricated from synthetic polymers. Yet, searching for an ideal mesh is an ongoing process, with continuous efforts directed toward developing upgraded implants by modifying existing products or creating innovative systems from scratch. In this regard, this review presents the most frequently employed polymers for mesh fabrication, outlining the market available products and their relevant characteristics, further focusing on the state-of-the-art mesh approaches. Specifically, we mainly discuss recent studies concerning coating application, nanomaterials addition, stem cell seeding, and 3D printing of custom mesh designs.

Chitosan and Cyclodextrins-Versatile Materials Used to Create Drug Delivery Systems for Gastrointestinal Cancers.

Gastrointestinal cancers are characterized by a frequent incidence, a high number of associated deaths, and a tremendous burden on the medical system and patients worldwide. As conventional chemotherapeutic drugs face numerous limitations, researchers started to investigate better alternatives for extending drug efficacy and limiting adverse effects. A remarkably increasing interest has been addressed to chitosan and cyclodextrins, two highly versatile natural carbohydrate materials endowed with unique physicochemical properties. In this respect, numerous studies reported on fabricating various chitosan and cyclodextrin-based formulations that enabled prolonged circulation times, improved cellular internalization of carried drugs, preferential uptake by the targeted cells, reduced side effects, enhanced apoptosis rates, and increased tumor suppression rates. Therefore, this paper aims to briefly present the advantageous properties of these oligo- and polysaccharides for designing drug delivery systems, further focusing the discussion on nanocarrier systems based on chitosan/cyclodextrins for treating different gastrointestinal cancers. Specifically, there are reviewed studies describing promising solutions for colorectal, liver, gastric, pancreatic, and other types of cancers of the digestive system towards creating an updated framework of what concerns anticancer chitosan/cyclodextrin-based drug delivery systems.

The Management of the Open Abdomen - A Literature Review.

An essential component of the concept of "Damage control surgery", laparostomy is the procedure by which the abdomen is deliberately abandoned open, the visceroperitoneal contents being temporarily protected by multiple technical means. Actual classification: Grade 1, without viscero-parietal adhesions or fixity of the abdominal wall (lateralization), divided into: 1A clean, 1B contaminated and 1C enteral fistula -cutaneous skin is considered clean); Grade 2, which develops fixation is subdivided into: 2A clean, 2B contaminated and 2C enteral fistula; Grade 3, "frozen abdomen", is divided into: 3A clean and 3B contaminated; Grade 4, defined as enteroatmospheric fistula, is a permanent fistula associated with the presence of granulation tissue and a frozen abdomen. Indications of the open abdomen are: damage control surgery, abdominal compartment syndrome, peritonitis, severe acute pancreatitis, vascular emergencies. Temporary abdominal closure may be achieved by following methods: skin only closure, â??Bogota bagâ?Â, opsite Sandwich technique, absorbable mesh, non-absorbable mesh or commercial zipper, vaccum asisted closure, each with its own advantages and disadvantages. Regarding the definitive closure this can be achieved by non mesh and mesh mediated techniques. Component separation technique anterior and posterior should be considered the elective repair procedure in parietal defects after laparostomy. Although several studies have been published, there is still no consensus in the literature on the positioning of prosthetic material in relation to parietal planes. Some authors suggest better results (relative to the rate of recurrence and complications) for implantation in the "sublay" position. Open abdomen is an important tool in the arsenal of the emergency surgery. Classification, indications, methods of temporary abdominal closure are evolving, as well as management of enterocutaneous fistulas and fascial closure, therefore permanent update is neccessary to offer patients the best care.

Emergency Surgery for Small Bowel Hemangioma. A review of the literature.

Background: Hemangiomas of the small intestine are tumors rarely found in practice. Patients usually present in emergency settings with anemia, gastrointestinal bleeding or abdominal pain. The purpose of this review of the literature is to evaluate the diagnostic modalities, therapeutic options and their results in cases of intestinal hemangiomas. Methods: This is a review of the recent literature concerning intestinal hemangioma with bleeding in the last five years including one case from our institution. Search criteria were defined using MeSH terms. The descriptive analysis was performed accordingly. Results: In the last five years there was a total of 24 cases ours being the 25th with a predominance of male patients (20 cases). Literature search found a low threshold for preoperative diagnostic (only in 28% of the cases). More than half of the tumors were in the ileum. Surgery is the main therapeutic option (in 88% of the cases). Nonsurgical treatment (endoscopic or radiological) can rarely be employed successfully. Conclusions: Surgery is the main treatment for larger hemangiomas while for smaller ones nonsurgical treatment methods are available.

Polytrauma: The European Paradigm.

This review of the literature aims to describe the main advantages and disadvantages of the trauma systems in Europe. Moreover, the purpose of this article is to present the last concepts regarding the management of the polytrauma patients and the newest sets of measures to prevent car crashes in European Union. The articles published regarding the management of the polytrauma patient and trauma systems were identified using PubMed search. Optimal management of major polytrauma requires a national trauma system which should detail every level of organization from the trauma centers to the every member of the trauma team. European trauma systems varies a lot depending on the country and the specialized trauma surgery training programs are more advanced in countries with complex trauma systems. Introducing road safety performance indicators for trauma management decreased the rate of deaths by car crashes in Europe.

Interventional Radiology in Splenic Trauma: If Not Now, Then When?

Introduction: The treatment of blunt splenic injuries showed major evolutionary changes, from fundamental/ basic splenectomy to nonoperative and endovascular treatment, "catheter surgery". Currently, in Trauma Centers, splenic angioembolization is considered the first-line intervention in trauma. This article presents the Bucharest Emergency Clinical Hospital experience in the use of splenic angioembolization, a therapeutic solution in accordance with contemporary practice and literature. Methods: This retrospective study includes patients with splenic trauma by blunt mechanism, in which diagnostic / therapeutic angiography was performed, hospitalized in the Clinical Emergency Hospital Bucharest between January 2006 and December 2019. The main endpoints of the study were: post-traumatic mortality, the need for surgery (laparoscopic/classic) to resolve splenic bleeding, the number of days of hospitalization, the need for hospitalization for more than 1 day in the intensive care unit, the day when the platelet count began to increase, the evolution of laboratory parameters (hospitalization, preangiography, postangiography/embolization, discharge). A secondary endpoint of the study was the frequency of complications that did not require surgery. Results: During the mentioned period in 64 patients treated nonoperatively, diagnostic angiography was performed (27 cases, group B) or therapeutic angiography (37 cases, group A). 26.56% of cases were 55 years old (55-81 years old), the predominance of males being obvious (62.5%). The mean value of the ISS was 21.7 +- 10.4, and 71.87% of cases presented ISS 16. The mean value of the ISS was 21.7 +- 10.4, and 71.87% of cases presented ISS 16. The degree of splenic injury (American Association for the Surgery of Trauma-Organ Injury Scale) presented the mean value 2.95. The degree of splenic lesion was statistically significantly more severe in group A (p 0.001) and preangiography hemoglobin values were significantly lower compared to hospitalization values (p 0.001) indicating the persistence of hemorrhage. Procedural failures occurred in 4.68% of cases, with zero mortality. Conclusions: Splenic interventional radiology is a safe, effective and rational procedure. The development of therapeutic protocols is necessary to allow maximum use of this procedure.

Retroperitoneal Haematoma - Still a Medical Challenge for Abdominal Trauma.

Introduction: The study is presenting a personal experience of a Trauma Centre Level I and is try to conclude on optimal medical attitude for patients with retroperitoneal hematoma, still a controversial topic for traumatologists. Material and Method: A retrospective analysis of 22 cases of post-traumatic retroperitoneal hematoma admitted on Bucharest Emergency Hospital between September 2018 August 2021 (including time of Covid-19 pandemic), is presented Results: The patients (males predominance, mean age 43, mean ISS of 23), benefited of nonoperative management on admission for 10 cases (45%) with a failure rate of 4/10 due to recurrent bleeding from spleen injuries and continuous bleeding from mesenteric vessels lesions. CT scan (73% - 16 cases) within 1 hour from the admission and emergency surgery were necessary for 12 cases (55%). 2 patients benefited of angioembolization on admission. Conservative attitude for retroperitoneal hematoma was adopted for 72% cases. Over-all mortality: 18% (4 patients, mean ISS of 36), among 82% polytrauma cases. Conclusions: Algorithm of treatment is adapted to every case of retroperitoneal hematoma but the following sequences are mandatory: rapid transportation to Trauma Centre Level I with medical help, correct resuscitation, immediate relevant imagistic (CT scan), emergency surgery prior to angioembolization (for hemodynamic instable patients) or after it, ICU stabilization of the patient and then definitive repair of the injuries. Despite all, mortality remains high.

Intraomental Splenic Implant - An Attempt of Reassessment.

The permanent risk of splenectomized patients to infectious complications, the most severe being overwhelming post splenectomy infection (OPSI), determined the search for solutions in order to diminish these evolutionary possibilities. Therefore, intraomental developsplenic autotransplantation seems to be a viable option which, according to some authors, would have beneficial effects by restoring (at least partially) the functions of the spleen. The article presents the current experience related to this procedure (principles of surgical technique, implant location, complications, post-procedural evaluation) in an attempt to bring it back to the attention of trauma / general surgery surgeons. The procedure is simple, fast and with minimal or no complications and should be applied after any post-traumatic splenectomy.

How and why do we screen for colorectal cancer?

After almost 50 years of data analysis, screening for colorectal cancer has proven to be an effective tool in reducing colorectal cancer mortality. However, implementing the optimal strategy represents a challenge for many healthcare facilities around the world. There is much discussion regarding how screening should be done, the optimal tools that should be used, and the proper timing for screening procedures. Another essential step is to maintain the adherence of patients to screening programs. Also, the recommendation for lowering the age to initiate screening is in progress, as there is an increase in colorectal incidence in people born after 1970.

The Management of Pancreatic Trauma - A Continuous Challenge.

Background: The aim of this analysis was to assess the factors that influence the severity of pancreatic trauma cases, also underlining the importance of early and accurate diagnosis and proper management of each case. Methods: This study is a retrospective analysis of patients that were presented to the Clinical Emergency Hospital of Bucharest, Romania, in several periods of time: 1985-1990 (50 patients); 1990-1999 (102 patients); 2000-2005 (56 patients); 2012-2019 (48 patients). Results: The mean age was around 40 years old, with predominance of male incidence in all the groups and traffic accidents (blunt trauma) as the main cause of injury. Most patients (almost 50% in each group) were operated on within the first 24 hours from hospital presentation. The general mortality rate varied: 42% (1985-1990), 23.5% (1990-1999), 12.7% (2000-2005) and 33% (2012-2015). Pancreatic mortality rate was 6% (1985-1990 and 1990-1999), 3.5% (2000-2005) and 8% (2012-2019). Conclusions: During the last 35 years, the preoperative diagnosis in patients with trauma of the pancreas remained a challenge and the treatment of the pancreatic trauma suffered a very interesting evolution- from the very frequent laparotomy to the nonoperative management and the damage control. These procedures produced a significant decreasing of the negative or nontherapeutic laparotomies. For the effectiveness of treatment, methods must be correlated with the lesion score.

The Bucharest ESTES consensus statement on peritonitis.

INTRODUCTION: Peritonitis is still an important health problem associated with high morbidity and mortality. A multidisciplinary approach to the management of patients with peritonitis may be an important factor to reduce the risks for patients and improve efficiency, outcome, and the cost of care. METHODS: Expert panel discussion on Peritonitis was held in Bucharest on May 2017, during the 17th ECTES Congress, involving surgeons, infectious disease specialists, radiologists and intensivists with the goal of defining recommendations for the optimal management of peritonitis. CONCLUSION: This document is an updated presentation of management of peritonitis and represents the summary of the final recommendations approved by a panel of experts.

Histopathological elements analyzed in dynamics in mechanical bowel obstructions - experimental study on laboratory animals.

Bowel obstruction is a syndrome that produces important alterations to the digestive tract, both macroscopically and microscopically. We conducted an experimental study using rats, Wistar strain, as subjects, dividing them into three groups. The group A consisted of six rats and served as control group, in the first day of the experiment a surgical procedure being performed to resect a small bowel and a colic segment to be analyzed microscopically afterwards. The 10 subjects from group B underwent a surgical procedure, in which we induced a mechanical bowel obstruction in the sigmoid colon, while to the 10 subjects from group C we induced a mechanical bowel obstruction in the small bowel. The initial protocol implied to observe the macroscopic modifications from five subjects from each group B and C after two days and afterwards to resect the digestive tract segment adjacent to the obstruction site. After another two days, a similar procedure was planned for the remaining subjects alive from both groups. A few subjects from group C died prematurely and the initial protocol had to be partially modified. The results highlighted an important distension of the digestive tract proximal to the obstruction, with important microscopically reactions, including edema, thrombosis, ischemic lesions and accumulation of polymorphonuclear neutrophils (PMN) and macrophages.

The Role of Laparoscopy in Abdominal Trauma: A 10-Year Review.

Laparoscopy is accepted in penetrating abdominal trauma (PAT), but its role in blunt trauma (BAT) remains a controversial one. Our study assessed the utility of diagnostic laparoscopy (DL) and therapeutic laparoscopy (TL) in abdominal trauma between December 2006 and January 2016. We analysed the indication for laparoscopy, type of lesions, TL, conversion rate, complications and length of hospital stay. 49 patients had a DL: 42 males and 7 females, with a mean age of 36.1+-13.3. We had 20 PAT and 30BAT. The indications for laparoscopy were: diagnosis of penetration in PAT, suspicion of hollow organ injury or diaphragm injury, active bleeding in organ injuries in BAT. 11/48 of preoperative ultrasounds and 4/48 of CT's were false negative. In 3 of 20 PAT, DL was negative and in 4 nontherapeutic. There were 4 TL's and 7 conversions. The main injuries in BAT were: 9 hollow organ perforations, 6 mesenteric lacerations, 2 diaphragmatic and 2 splenic injuries. There were 10 TL's, 9 conversions and 14 TL. The operative time and length of hospital stay was higher in the conversion group. There were 6 complications and 3 mortalities. There were no missed injuries. An unnecessary laparotomy was avoided in 18/49 cases (36.73%). In selected cases of PAT and BAT with equivocal clinical and imaging diagnosis, laparoscopy is a useful tool with therapeutic role, that reduces unnecessary laparotomies, complication rate and hospital stay.

Peppermint Essential Oil-Doped Hydroxyapatite Nanoparticles with Antimicrobial Properties.

This study aimed at developing an antimicrobial material based on hydroxyapatite (HAp) and peppermint essential oil (P-EO) in order to stimulate the antimicrobial activity of hydroxyapatite. The molecular spectral features and morphology of the P-EO, HAp and hydroxyapatite coated with peppermint essential oil (HAp-P) were analyzed using Fourier-transform infrared (FTIR) spectroscopy and scanning electron microscopy (SEM). The coating of the HAp with the P-EO did not affect the ellipsoidal shape of the nanoparticles. The overlapping of IR bands of P-EO and HAp in the HAp-P spectrum determined the formation of the broad molecular bands that were observed in the spectral regions of 400-1000 cm-1 and 1000-1200 cm-1. The antibacterial activity of the P-EO, HAp and HAp-P were also tested against different Gram-positive bacteria (methicillin-resistant Staphylococcus aureus (MRSA) 388, S. aureus ATCC 25923, S. aureus ATCC 6538, E. faecium DSM 13590), Gram-negative bacteria (Escherichia coli ATCC 25922, E. coli C5, P. aeruginosa ATCC 27853, P. aeruginosa ATCC 9027) and a fungal strain of Candida parapsilosis. The results of the present study revealed that the antimicrobial activity of HAp-P increased significantly over that of HAp.

Adsorption of Pb (II) Ions onto Hydroxyapatite Nanopowders in Aqueous Solutions.

Contamination of water with heavy metals such as lead is a major worldwide problem because they affect the physiological functions of living organisms, cause cancer, and damage the immune system. Hydroxyapatite, (Ca5(PO4)3OH) is considered one of the most effective materials for removing heavy metals from contaminated water. The hydroxyapatite nanopowders (N-HAp) obtained by a co-precipitation method were used in this research to determine the effectiveness in removing lead ions from contaminated solutions. In this study, we have investigated the structure and morphology of N-HAp nanopowders using X-ray diffraction (XRD), electronic transmission microscopy (TEM), and scanning electron microscopy (SEM). The structure information was also obtained by spectroscopy measurements. The Fourier transform infrared spectroscopy (FTIR) and Raman spectroscopy measurements revealed the presence of peaks corresponding to the phosphate and hydroxyl groups. The ability of N-HAp nanopowders to adsorb lead ions from aqueous solutions were established. The results of the kinetic and equilibrium studies on the removal of Pb (II) from aqueous solution revealed that the adsorption of lead (II) cations is due to the surface reaction with the hydroxyl terminal groups on the adsorbent and the combination of the positive charges of the metal cations with the negative charges on the adsorbent surfaces. These observations could validate the use of these ceramic nanopowders in ecological remediation strategies.

Sarcopenia is a Predictive Factor for Postoperative Morbidity and Mortality in Patients Having Radical Gastrectomy for Cancer.

Introduction: Patients with gastric cancer are frequently malnourished with 30% to 38% of them losing more than 10% of their weight in preceding six months. Sarcopenia represents a decrease in the skeletal muscle mass and function and is usually associated with the aging process. The prevalence of sarcopenia in patients with gastric cancer is reported to be as high as 57.7%. Although many studies support the negative impact of sarcopenia in patients with gastric cancer, contradictory results are also present in the literature. The objective of this study is to investigate if sarcopenia is correlated with increased morbidity and mortality, in patients with gastric adenocarcinoma. Methods: We studied retrospectively all patients having radical resection for gastric adenocarcinoma managed in the Emergency Hospital of Bucharest between December 2014 and May 2016. ImageJ software was used to measure the patients' body composition. We identified the L3 landmark and extracted that corresponding single cross-sectional image contained within a CT study. Results: We reviewed 89 patients who had gastrectomy for cancer, but 11 Computed Tomography images were not available for analysis. Therefore, the study group consisted of 78 patients of which 50 were (64.1%) males and 28 (35.9%) females. The average age of patients diagnosed with gastric cancer was 67.7 years (range 22 to 92 years). The primary tumor location was the middle third of the stomach in 45 patients (57.7%), and the second in the lower third of the stomach in 29 patients (37.2%). There were 72 (92.3%) patients who were living on discharge, with mortality in 6 (7.7%) patients. 72.22% of patients are sarcopenic, and 27.78% were non-sarcopenic. The average sarcopenia value for both males and females is 43.77. The greatest number of patients had a skeletal muscle index between 40.00 and 45.00. The second greatest is between 35.00 and 40.00. The muscular skeletal index correlated with the age of the patients. The overall complications rate and the surgical site infection rate correlated with the sarcopenia. Conclusions: Sarcopenia is highly prevalent in patients having surgery for gastric cancer in Romania and correlates with increased postoperative morbidity. Especially with the increased trend for neoadjuvant therapy, the multidisciplinary team should evaluate and address sarcopenia through the perioperative period.